Thursday, June 29, 2017

Across the UK, but especially in
England and Wales, the response to crime and management of those who break laws
(especially those who sexually abuse) is shifting. The Conservative government
has recently instituted changes to the management of offenders across the board
with its transforming
rehabilitation agenda. This agenda shifts the offender management landscape
significantly, with one of the most contentious issues being the privatisation
in the management of all low and medium risk offenders to Community
Rehabilitation Companies on a payment-by-results model, with all high risk
offenders remaining with a downsized, specialized probation service. Interestingly,
this approach does not apply to all low and medium risk offenders. Sex offenders
– regardless of their risk level – will be managed by a downsized probation
service. In other words, all sex offenders are considered high risk regardless
of the actual risk they pose.

In addition to these practical
changes, there have been significant changes in policy and practice around sex
offender treatment programmes. Up until recently, the cornerstone of sex
offender treatment in the UK was linked to risk level, required that those
entering treatment first admit guilt, and used cognitive-behavioural approaches.
While there had always been a degree of scepticism about the impact and utility
of sex offender treatment programmes, there was a view that programmes needed
to be evidence based (Mann,
2014; Ministry
of Justice, 2010) – or at least based on sound science – and that doing
something was better than doing nothing. The Ministry of justice argued that:

·Sex offender treatment models do not have a
sufficient evidence base

·They can therefore only be regarded as
experimental

·There are engagement issues with offenders
participating

·There are methodological limitations to the
research and evaluation processes (especially meta-analysis)

While some may argue with the
Ministry of Justice’s perspective on sex offender treatment programmes in
general, it was nonetheless respectable and defensible. However, this blog’s
concern is that the demand for a solid evidence base seems to have started to
dissolve. The swing from left to right with the conservative government, an
increase in ideological (as opposed to science-based) policies, austerity and privatisation
has brought about changes, but not necessarily what the Ministry advocated.
What we have now is a change in the treatment of sexual offenders that might
have its roots in research, but is not evaluated, evidenced based or necessarily
coherent. Only time will tell; exit the “Sex Offender Treatment Programme” (SOTP)
and enter “Horizon” and “Kaizen”.

Earlier this year (in March) the
Ministry of Justice rapidly introduced two new sex offender treatment programmes:
Kaizen (for high risk, high need, high
priority offenders) and Horizon (for
medium risk offenders) to replace existing SOTP programmes. Initially, it came
as a surprise to many in the field, although there had long been murmurs of a
change of direction, but recently it has emerged that there were issues
relating to recent programmes and a related report was apparently suppressed (Daily
Mail, 2017).

At first glance and on paper, the
two new programmes look good enough. They appear to be strengths-based,
positively orientated and focused on ideas found in the Good Lives Model and
related approaches; this is certainly a welcome change from approaches of the
past. The idea is that they build on and adapt the recently jettisoned SOTP –
they are an update and remodelling of existing practices. As with previous
versions of sex offender treatment in the UK neither Horizon or Kaizen are
aimed at low risk sex offenders, but unlike previous programmes they have
capacity for “Deniers”/”individuals who are maintain their innocence” which is
a welcome shift. Both programmes are based on the sex offender treatment
literature and pull together material from a range of sources.

-Kaizen is based upon Risk, Need and Responsivity;
multidimensional views of needs and interventions to be holistic, therefore
incorporating biological, psychological and social aspects; strengths based approaches;
desistance; and adaptive, appropriate and easy to engage with approaches to
learning.

-Horizon is based upon criminogenic needs and the
recognition that sex offenders and non-sex offenders are similar and therefore
addresses poor problem solving skills, poor self-regulation and relationship
problems.

While these two new programmes
are purportedly evidence based, it may be better to say they are evidence
informed. In the pure research/evaluation/piloting sense they are not evidence
based, having not been tested rigorously. This is ironic given the Ministry of Justice’s
need for rigorous evidence in other areas of sex offender treatment/support
(i.e., Circles of Support and Accountability). From our perspective, there are
further ironies. New models often attract doubt and even scorn in the
professional literature. There can be a paradox of putting down unproven
innovation at the same time as there can be nothing proven until there is
innovation. While we applaud the development of these new models and hope that
they are successful, it is nonetheless strange to see that the Ministry of
Justice’s complaints about unproven methods has led to more unproven methods
being championed.

Therefore we need to make sure
that the treatment, rehabilitation and (re)integration is fit for fit for
purpose, publically accountable, transparent and not directed by “political”;
especially in the arenas of sex offending given the increased public, media and
political visibility the issue has. As Ruth Mann observed in 2014,
the evil twin of evidence-based policy-making is policy-based evidence-making.
It is for exactly this reason that we need more dialog and debate and not less.

The most commonly used risk
assessment tools for predicting sexual violence focus almost exclusively on
static, historical factors. Consequently, they are assumed to be unable to directly
inform the selection of treatment targets, or evaluate change. However,
researchers using latent variable models have identified three dimensions in
static actuarial scales for sexual offenders: Sexual Criminality, General
Criminality, and a third dimension centered on young age and aggression to
strangers. In the current study, we examined the convergent and predictive
validity of these dimensions, using psychological features of the offender
(e.g., antisocial traits, hypersexuality) and recidivism outcomes. Results
indicated that (a) Sexual Criminality was related to dysregulation of sexuality
toward atypical objects, without intent to harm; (b) General Criminality was
related to antisocial traits; and (c) Youthful Stranger Aggression was related
to a clear intent to harm the victim. All three dimensions predicted sexual
recidivism, although only General Criminality and Youthful Stranger Aggression
predicted nonsexual recidivism. These results indicate that risk tools for
sexual violence are multidimensional, and support a shift from an exclusive
focus on total scores to consideration of subscales measuring psychologically
meaningful constructs.

Could
you talk us through where the idea for the research came from?

In French/European countries,
professionals tend to be lukewarm towards structured risk assessment. As a
native French speaker, I often became involved in debates about the pros and
cons of actuarial assessment. By participating in these debates, I became
cognizant of the conceptual limitations of this approach. Although many criticisms
were warranted (e.g., limited predictive accuracy), one always “struck a nerve”
with me: that risk factors are clinically meaningless statistical entities that
do not enable a true comprehension of the offender.

Since the dawn of psychology,
observable behaviors have been used to infer personality traits (or dynamics of
the unconscious mind). In this context, why would risk factors, i.e., measures
of criminogenic behaviors, be any different? Although risk factors are first
and foremost statistical correlates of recidivism, they are also windows into
the psychological and sociological mechanisms that lead individuals to commit
crimes. This latent trait approach has been described in the works of Beech and
Ward (2004) and Mann, Hanson, and Thornton (2010). Their theoretical frameworks
for sexual offender risk assessment illustrated how to integrate static,
stable, and acute risk factors in etiological models of risk that have far more
clinical resonance than “dry” risk scales. Luckily for me, nobody had (yet)
thought to empirically test these models. Thus, it became the overarching goal
of my doctoral thesis.

At the start of my Ph.D., I had
the luck of being put in touch with R. Karl Hanson and his research team (Kelly
M. Babchishin, Maaike Helmus) by my director, Jean Proulx. It turned out that
Karl had a project quite similar to mine; he wanted to explore the latent
psychological constructs underlying the items in sexual offender risk scales.
The goal was to shift practice from the assessment of unidimensional and
“atheoretical” risk scores to the assessment of multiple risk-relevant
psychological propensities. These constructs could then be combined in specific
ways depending on the outcome of interest. In a way, we were exploring the
building blocks of risk rather than its finite structure.

This lead to our factor analysis
of the Static-99R and Static-2002R items (Brouillette-Alarie, Babchishin,
Hanson, & Helmus, 2016). We quickly realized that the literature on this
topic was substantive; we found 13+ studies on the factor structure of the
Static-99/2002/R. Most studies obtained a solution of 3 factors (ours
included): sexual criminality, general criminality, and a third factor related
to age and victim characteristics. Unfortunately, none of the studies had
conducted any convergent validity analyses. They interpreted the factors by
looking at the items constituting each construct. Although this was a good
start, we thought that more empirically grounded interpretations were
necessary. This led us to the current paper.

What
kinds of challenges did you face throughout the process?

Doing convergent validity
analyses was, in fact, the easy part. The hard part was coming up with the
factor structure in the first place (in Brouillette-Alarie et al., 2016). Jean
Proulx and I started the factor analysis project in the spring of 2011, as part
of my master’s thesis. Then, we involved Karl’s team, who gave us access to
worldwide validation studies of the Static-99. They also (rightfully) told us
that our factor analytic procedures were outdated and that we needed to redo
everything from scratch (a common occurrence according to Maaike!). We
dutifully did so, which led to our 2016 paper.

What do
you believe to be the main things that you have learnt about the nature of the
risk dimensions of the Static-99R and Static-2002R?

First, we learnt that sexual
deviance is not a cohesive whole. Variables concerning sexual criminality clustered
in two negatively correlated factors: Persistence/Paraphilia and Youthful
Stranger Aggression. These factors were associated with different ends of the agonistic
continuum (Knight, Sims-Knight, & Guay, 2013). Persistence/Paraphilia was
characterized by modus operandi devoid of physical coercion and intent to harm,
while Youthful Stranger Aggression was associated with sexual sadism and hostility.
Furthermore, these two dimensions did not predict the same types of recidivism:
the former was exclusively related to sexual recidivism, while the latter was
predictive of all types of recidivism (like General Criminality). Without
surprise, Persistence/Paraphilia was more common in sexual aggressors of
children, and Youthful Stranger Aggression was more common in sexual aggressors
of women. In sum, our results encourage researchers and evaluators to clearly differentiate
between pedophilic and sadistic tendencies, as they refer to substantially
different constructs. More often than not, they will not characterize the same
offenders. In some rare cases (e.g., sadistic pedophiles), they will
nevertheless converge into a very high level of sexual recidivism risk.

Second, we found a strong
General Criminality factor that naturally converged with
antisocial/psychopathic traits and domains of the Level of Service/Case
Management Inventory (LS/CMI; Andrews, Bonta, & Wormith, 2004). This
confirms that sexual recidivism risk comprises a general deviance dimension
that is common to sexual and nonsexual offenders. The generality of criminal
behavior in sexual offenders has already been highlighted by numerous authors
(e.g., Lussier, LeBlanc, & Proulx, 2005).

Now
that you’ve published the article, what are some implications for
practitioners?

Although it is not yet ready to
be implemented in forensic practice, we hope that sexual offender risk scales (and
those scoring them) will adopt dimensional scores in addition to total scores. Sexual
recidivism risk is unanimously considered to be multidimensional, and our
current risk tools do not convincingly reflect that. It is more clinically
relevant to conceptualize risk as the interaction between psychological
constructs and the social environment than the sum of discrete correlates. Our
research program tries to bridge the gap between those two perspectives.

Tuesday, June 13, 2017

The US House of Representatives recently passed HR1761.
Within a few days, ATSA’s Executive Board of Directors issued a cautionary statement. The latest in a long tradition of
tough-on-crime measures, this law – now on its way to the Senate – imposes
harsh mandatory sentences (15 years at a minimum) for distributing sexually
explicit images of minors. It aims to "criminalize the knowing consent of the
visual depiction, or live transmission, of a minor engaged in sexually explicit
conduct." Certainly, there is no question that we need efforts to clamp
down on the distribution of media depicting child sexual abuse; there’s a lot
of it out there, and many professionals have seen the direct harm that it can
cause.What’s the
big deal with this becoming law?

Unfortunately, critics of the
law, including many ATSA members, have noted that the wording of the law is so
vague that it could easily lead to adolescents serving very serious prison
sentences for sending pictures of themselves naked to their boyfriend or
girlfriend. It might make sense for readers to stop, pause, and consider our
own impulsive acts as teenagers. Smartphones are ubiquitous amongst teens, as
are questionable decisions. In some imaginable scenarios, a more effective
response might be to require parents to take away the smartphone and ground
their son or daughter for a month. A 15-year mandatory minimum sentence? Even
adults can be prone to stupid online mistakes, whether sharing pictures with
the wrong person, sending angry emails without thinking, or making an impulse
purchase that they later regret. Don’t kids need guidance and education more
than punishment? Going to prison at 17 and coming out at 32?

Of course, it is easy to complain
about the cavalier ways that unhelpful legislation gets passed. One is reminded
of policymakers unconcerned when their wide-cast nets catch more dolphins than
tuna. On the other hand, professionals in the field often express deep
disillusionment that our knowledge and expertise are not tapped in the creation
of these laws. For many years it has seemed that we have to be on constant
guard against well-intended but ultimately ignorant legislation.

The real story behind the news
item is how difficult it is to fully grasp the complexities involved. The world
has a long and unfortunate history of causing harm when attempting to legislate
sexual behavior. Again, there is no question that young people should be
protected from abuse. This outcome virtually always means more to professionals
in our field, by far, than the income we receive. Still, the fact remains that
sexuality is complicated. Adults sexting each other may seem “deviant” to some
and yet is very common. The bright line is consent: one person’s intrusion is
another’s intimacy. Who gets to make the call? I am quite certain that the
restrictive nature of mandatory minimum sentences will not clarify this.

One colleague wondered aloud
whether one purpose of the law might be to make it easier for prosecutors to
negotiate ever-more-stringent plea agreements. If this is the case, one wonders
to what extent this constitutes own form of bullying of young people by adults.
It is the author’s belief that we will all benefit more from earnest attempts
to help young people, including both those who abuse as well as those who are
victimized than we will from this kind of punitive approach. Judicial
discretion, assessment, and treatment where it is needed may not be perfect,
but all of the indicators are that these are more effective approaches than
mandatory minimum sentences for sexting.

Frankly, the author applauds
ATSA’s board of directors not so much for writing their response, but for the
restraint they showed in doing so. It is difficult to imagine how lawmakers
would not imagine the downside impact of their actions or recognize how imprecisely
they’ve defined their intentions.

For all of the above reasons, I know I speak for many
when I urge readers in the US to contact their senator. Perhaps someday our
lawmakers can use empirical measures of likely effectiveness of proposed laws
similar to the ways that the Congressional Budget Office uses expert review to
evaluate budgets.

Monday, June 5, 2017

Historically, there has
been a significant divide in the therapeutic community between professionals
working those harmed by sexual violence and those who have caused the harm.
However, for one professional, Alison C. Hall, the Executive Director of the Pittsburgh
Action Against Rape (PAAR), the importance of understanding the treatment needs
of both victims and offenders including the benefits of collaborating between
both types of treatment providers has been her lifelong mission and vision.

I recently had the
privilege of interviewing Alison about her unique perspective and work with
both victims of sexual violence, sex offenders, and bystanders. I was impressed
by her dedication to the field of prevention.

Alison spoke passionately
about how the movement towards primary prevention is one that revolves around
social change. While Alison is a firm believer that rape crisis centers across
the United States have indeed reduced sexual violence, she stressed the
importance of collaborating with sex offender treatment providers. As she
explained, “We can’t do this work alone. It is essential that we partner with
others who want to end sexual violence.”

In 2006, Alison’s passion
and determination to bridge the gap between treatment providers of sexual assault
and sex offenders led to her efforts to establish the first sex offender court
in the state of Pennsylvania. She convened a meeting with victim services,
prosecutors, police investigators, public defenders, judges and treatment
providers to discuss issues pertinent to sexual abuse and to understand each
other’s work. She shared, “This was the first time these professionals were in
the same room together discussing sexual abuse in Allegheny County.” As a
result of that meeting, strong relationships developed and the first Sex
Offender Management & Containment (SOMAC) Task Force was formed and
continues to meet regularly.

In recognition of her
leadership in convening the first sex offender court in Pennsylvania she was
awarded the Gail Burns-Smith Award in 2011. As she humbly stated, “It was the
strength of the relationships of this task force that led to the creation of
the first sex offender court in the state of Pennsylvania.”

Alison has worked at PAAR
for 14 years in various capacities; she has been the Executive Director for
almost 9 years. PAAR is dedicated to assisting victims of sexual abuse and
ending sexual violence in the community. PAAR has served victims in Allegheny County
for over 45 years, and is one of the first agencies in the US to serve victims
of sexual assault. She shared, “It is the most motivating place I have ever
worked.”

Alison was especially proud
to share that through PAAR’s on-going outreach, each college in Pittsburgh
currently recognizes PAAR as an important partner in the prevention and
treatment of sexual abuse, and seeks PAAR’s direction to help develop
appropriate responses to victims of sexual violence on their campuses.

As a member of the ATSA
Prevention Committee, Alison has decided to run as the prevention
representative to the ATSA board. When asked what her vision for ATSA’s future
is, should she be accepted, Alison shared, “I believe that when those who
specifically treat individuals who have sexually offended collaborate with
professionals working with victims, we make greater strides in bringing about
the social change required to end sexual violence.”

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

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The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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